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Choosing a provider: Understanding the medical and midwifery models of care

What is the difference between the midwifery and the medical model of care?

One of the first decisions that a woman makes, after her discovery of pregnancy, is her choice of care provider. In most countries, there are two basic care providers available- the obstetrician and the midwife. There are many factors that contribute to which provider will work best for your birth. A basic understanding of the common differences in their approach can help you make the best decision for your family.

Midwifery model of care-

Most midwives, whether working out of a hospital or attending home births, practice what is known as the “midwifery model of care.” The basic midwifery approach to birth and the pregnant woman tends to be more holistic. This means that they look at all factors which may contribute to the health and safety of the woman and her birth. Emotions, living situations, nutrition, and education should all be addressed by someone providing the midwifery model of care.

At the time of birth, this care provider will be aware of and trained to spot things that may go wrong, but will, overall, consider childbirth a natural process that frequently proceeds normally and safely.

Those trained in the midwifery model of care routinely refer out to an obstetrician when they observe that the pregnant woman needs to be cared for by someone with a deeper knowledge of pathology.

The Citizens for Midwifery note that,

“The application of this woman-centered model of care has been proven to reduce the incidence

of birth injury, trauma, and cesarean section.”

Medical model of care-

A practitioner using the medical model of care, as is common among western medical doctors, tends to approach the patient from a problem solving approach, searching for the defect or dysfunction and trying to fix it. Unlike the midwifery model of care that seeks to understand the whole person and prevent unnecessary intervention or surgery, things are viewed from a pathological model searching for the problem and a solution.

Obstetricians, who provide the bulk of medical care for birthing women in the United States of

America, frequently approach their patients and their pregnancy and birth from this angle.

Which is right for me?

When choosing your care provider, there are many factors to consider. One would be your own philosophy towards birth. Do you view birth as a normal life event or as a pathology or disease?

Assessing your own beliefs will help you choose a care provider that best matches your own needs.

Another thing to consider is your own health and wellbeing. If you or your pregnancy are high risk, for some reason, then choosing an obstetrician who approaches birth from the medical model of care and who is versed in your risk factors in particular may be the choice that works best for you and your family.

It is also important to realize that not all midwives use the midwifery model of care and not all obstetricians use the medical model of care. You may be able to find an OB who views birth as a normal, healthy life event and approaches it with minimal interventions. You will also find midwives who have come to view birth as dangerous and pathologic and who have high intervention and cesarean section rates in their practices. Interviewing your individual care provider and asking for experiences from other mothers, doulas, and your childbirth educator will help give you some idea of their practice and philosophy.

Take your time and research your care provider. Your birth and your baby are worth the effort!

References:

Citizens for Midwifery- “Midwives Model of Care” brochure

http://cfmidwifery.org/mmoc/brochure_text.aspx

CIMS- Coalition for Improving Maternity Services

http://www.motherfriendly.org/MFCI/

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